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      Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012

      research-article
      Author(s): 1 , 2
      Publication date (Electronic):
      Journal: BMJ Open
      Publisher: BMJ Publishing Group
      Keywords: PUBLIC HEALTH, Health policy , Diabetes, Socioeconomic status, KNHANES

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          Abstract

          Objective

          To examine the relationship between socioeconomic status (SES) and type 2 diabetes using the Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012.

          Design

          A pooled sample cross-sectional study.

          Setting

          A nationally representative population survey data.

          Participants

          A total of 14 330 individuals who participated in the KNHANES 2010–2012 were included in our analysis.

          Primary outcome

          Prevalence of type 2 diabetes.

          Results

          The relationship between SES and type 2 diabetes was assessed using logistic regression after adjusting for covariates including age, gender, marital status, region, body mass index, physical activity, smoking and high-risk drinking behaviour. After adjustment for covariates, our results indicated that individuals with the lowest income were more likely to have type 2 diabetes than those with the highest income (OR 1.35; 95% CI 1.08 to 1.72). In addition, lower educational attainment was an independent factor for a higher prevalence of type 2 diabetes in Korea.

          Conclusions

          These findings suggest the need for developing a health policy to ameliorate socioeconomic inequalities, in particular income and education-related disparities in type 2 diabetes, along with risk factors at the individual level. In addition, future investigations of type 2 diabetes among Koreans should pay more attention to the social determinants of diabetes in order to understand the various causes of the condition.

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          Most cited references24

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          The social determinants of health: coming of age.

          Paula Braveman, Susan Egerter, David Williams (2011)
          In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusing on upstream social determinants-including economic resources, education, and racial discrimination-that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions. Research priorities include measuring social factors better, monitoring social factors and health relative to policies, examining health effects of social factors across lifetimes and generations, incrementally elucidating pathways through knowledge linkage, testing multidimensional interventions, and addressing political will as a key barrier to translating knowledge into action.
          Article 0 comments Cited 520 times – based on 0 reviews     Review now
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            Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.

            M Winkleby, D E Jatulis, E. Frank … (1992)
            Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.
            Article 0 comments Cited 246 times – based on 0 reviews     Review now
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              Socioeconomic status and health. The challenge of the gradient.

              N Adler, S Boyce, M Chesney … (1993)
              Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.
              Article 0 comments Cited 199 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2014
                Publication date (Electronic): 19 August 2014
                Volume: 4
                Issue: 8
                Electronic Location Identifier: e005710
                Affiliations
                [1 ]Centre for Research on Inner City Health, St. Michael's Hospital , Toronto, Ontario, Canada
                [2 ]Graduate School of Public Health, Seoul National University , Seoul, Korea
                Author notes
                [Correspondence to ] Dr Jongnam Hwang; hwangjo@ 123456smh.ca
                Article
                Publisher ID: bmjopen-2014-005710
                DOI: 10.1136/bmjopen-2014-005710
                PMC ID: 4139629
                PubMed ID: 25138810
                SO-VID: 98a14eaa-a03f-44a9-b423-c35c3fe60568
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 16 May 2014
                Date revision received : 14 July 2014
                Date accepted : 1 August 2014
                Categories
                Subject: Public Health
                Subject: Research
                Subject: 1506
                Subject: 1724
                Subject: 1703

                ScienceOpen disciplines: Medicine
                Keywords: public health,health policy ,diabetes,socioeconomic status,knhanes
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: public health, health policy , diabetes, socioeconomic status, knhanes

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